Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Indiana for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Indiana only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Indiana (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

219 Health Network Inc (NPI 1093213506)

219 Health Network Inc is a family medicine physician provider located in East Chicago, Indiana. This profile covers 0 Medicare and 80 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Medicaid: Complete Services Breakdown

Field	Value
Entity Type	Organization
Organization	219 Health Network Inc
Address	100 W Chicago Ave Ste F
City	East Chicago
State	IN
ZIP	46312
Taxonomy	Family Medicine Physician
NPI Enumerated	January 30, 2018

Payer Source	Total Paid
Medicaid	$2.6M
Medicare	$0

Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.

80 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	17,530	$50	$789K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	11,620	$70	$766.7K
59425	This service is considered a mini global code for the provider who provides only four to six of the patient’s antepartum visits. This can happen when the patient transfers out of the practice prior…	3,230	$80	$248.6K
59426	This service is considered a mini global code for the provider who provides seven or more antepartum visits. This can happen when the patient transfers out of the practice prior to delivery or the…	1,020	$70	$70.4K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	800	$80	$61K
99383	The provider performs a well–patient visit for a child who is between the ages of 5 and 11 who meets the definition of new patient.	630	$100	$59.6K
99232	The provider sees a patient for a subsequent hospital inpatient or observation care visit involving evaluation and management (E/M). The visit involves a moderate level of medical decision making or…	2,680	$20	$56.2K
90833	In this add–on service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient, in addition to an evaluation and management service in the…	2,160	$30	$53.9K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	470	$80	$36.7K
99384	The provider performs a well–patient visit for an adolescent who is between the ages of 12 and 17 who meets the definition of new patient.	400	$90	$35.6K

Showing 1–10 of 80

Medicaid: Competitive Analysis & Benchmarks

How this provider's Medicaid billing volume and revenue compare to other Indiana providers billing the same CPT/HCPCS codes.

Claims Volume vs. Indiana Distribution

219 Health Network Inc — 3 of 25 codes billed far more than typical (above p95)

p5–p95 (all providers)p25–p75MedianThis providerOutlier

Rank Distribution — Indiana

Full comparison — all codes billed, vs. Indiana median

80 rows

CPT/HCPCS Code	Description	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	236	2,120	870	$60	$450.6K
99213	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the…	232	2,380	920	$50	$376.8K
T1015	Clinic visit/encounter, all-inclusive	161	400	5,220	$20	$360.2K
99218	N/A	35	50	180	$350	$327.2K
59426	This service is considered a mini global code for the provider who provides seven or more antepartum visits. This can happen when the patient transfers out of the practice prior to delivery or the…	89	160	1,390	$70	$294.8K
99391	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	143	280	880	$80	$267.2K
59425	This service is considered a mini global code for the provider who provides only four to six of the patient’s antepartum visits. This can happen when the patient transfers out of the practice prior…	63	190	1,680	$70	$264.2K
J2426	Injection, paliperidone palmitate extended release (invega sustenna), 1 mg	8	10	270	$350	$251.6K
99392	Preventive medicine services are provided to individuals who are not in need of any immediate medical attention, but need to undergo a periodic health checkup as a preventive measure. Well–baby…	177	290	770	$80	$250.8K
90832	In this service, the provider performs psychotherapy, a series of techniques for treating the psychiatric disorders of the patient. The treatment session with the patient typically lasts for anywhere…	283	430	630	$40	$243.8K

Showing 1–10 of 80

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
219 Health Network Inc	IN	Federally Qualified Health Center (FQHC)	$0	$2.7M
Andrea Deleo	IN	Neurology Physician	$427.4K	$0
Mario Robbins	IN	Psychiatry Physician	$297.4K	$0
Kevin Parikh	IN	Urology Physician	$222.4K	$0
Bruce Yalowitz	IN	Urology Physician	$210K	$0
Edward Capoccia	IN	Urology Physician	$190.6K	$0
Ryan Swearingen	IN	Urology Physician	$163.2K	$0
Ted Vellos	IL	Urology Physician	$130.2K	$0
Amit Kakkar	IN	Interventional Cardiology Physician	$85.7K	$2.7K
Zalak Patel	IN	Family Nurse Practitioner	$15K	$0

Provider	State	Taxonomy	Medicare Revenue	Medicaid Revenue
St Catherine Hospital Inc	IN	General Acute Care Hospital	$0	$32.3M
Emergency Physician Associates Of Indiana PC	IN	Emergency Medicine Physician	$0	$4.7M
Amit Saparia Dds Inc.	IN	General Practice Dentistry	$0	$3.9M
Cep America LLC	IN	Emergency Medicine Physician	$0	$3.7M
Southlake Community Mental Health Center Inc.	IN	Substance Use Disorder Rehabilitation Clinic/Center	$0	$3.2M
Ralph Richter	IN	Orthopaedic Surgery Physician	$36.8K	$296.9K
Samer Abbas	IN	Interventional Cardiology Physician	$222.5K	$0
Dean Ferrera	IN	Interventional Cardiology Physician	$184.3K	$21.2K
Priyanka Kumar	IN	Urology Physician	$180.1K	$0
Farzana Khan	IN	Psychiatry Physician	$16.5K	$131.2K

219 Health Network Inc — Billing Profile & Reimbursement Data

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219 Health Network Inc — Billing Profile & Reimbursement Data

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Medicaid: Total Revenue Breakdown by CPT/HCPCS Code

Medicaid: Complete Services Breakdown

Medicaid: Competitive Analysis & Benchmarks

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